Patient Story

Jared’s Story

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Jared was a 36-year old married veteran who had returned from Afghanistan, where he had served as an officer. He went to the Veterans Affairs outpatient mental health clinic complaining of having “a short fuse” and being “easily triggered.”

Jared's symptoms involved out-of-control rage when startled, constant thoughts and memories of death-related events, weekly vivid nightmares of combat that caused trouble sleeping, anxiety and a loss of interest in hobbies he once enjoyed with friends.

Although all of these symptoms were very distressing, Jared was most worried about his extreme anger. His “hair-trigger temper” caused fights with drivers who cut him off, cursing at strangers who stood too close in checkout lines, and shifts into “attack mode” when coworkers startled him by accident. In a recent visit to the doctor, he was drifting off to sleep in the exam table. A nurse brushed by his foot, and he leapt up, cursing and threatening her — scaring both the nurse and himself.

He kept a handgun in his car for self-protection, but Jared had no intent to harm others. He had deep remorse after a threatening incident and worried that he might accidently hurt someone.

These moments reminded him of a time in the military when he was on guard at the front gate. While he was dozing, an enemy mortar round stunned him into action.

Jared was raised in a loving family that struggled to make ends meet as Midwestern farmers. At age 20 he joined the U.S. Army and deployed to Afghanistan. He described himself as having been upbeat and happy before his army service. He said he enjoyed basic training and his first few weeks in Afghanistan, until one of his comrades got killed. At that point, all he cared about was getting his best friend and himself home alive, even if it meant killing others. His personality changed, he said, from that of a happy-go-lucky farm boy to a frightened, overprotective soldier.

When he returned to civilian life, he got a college degree and a graduate business degree. He chose to work as a self-employed plumber because of his need to stay alone in his work. He had been married for seven years and was the father of two young daughters. In his retirement, he looked forward to woodworking, reading and getting some "peace and quiet."

Jared was diagnosed with posttraumatic stress disorder. His main concerns were due to his symptoms of fear, and his aggression when startled by someone. Jared was jittery and always on the lookout for danger. He also had intrusive memories, nightmares and flashbacks.

Jared’s attempts to reduce the risk of conflict have reduced his social and career opportunities. For instance, his decision to work as a plumber rather than to use his M.B. A. seemed based largely on his effort to control his personal space.

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This patient story is excerpted from Understanding Mental Disorders: Your Guide to DSM-5.

Understanding Mental Disorders is a consumer guide designed to promote education and understanding among anyone who has been touched by mental illness.